| |
5952 Blackstone Way Nine Mile Falls WA 99026 | |
(509) 464-3627 | |
(509) 466-9517 |
Full Name | |
---|---|
Speciality | Clinic/Center |
Location | 5952 Blackstone Way, Nine Mile Falls, Washington |
Authorized Official Name and Position | Donna Poe (CREDENTIALING SPECIALIST) |
Authorized Official Contact | 5099356001 |
Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
Mailing Address | Practice Location Address |
---|---|
Po Box 808 Chewelah WA 99109-0808 Ph: (509) 935-6001 | 5952 Blackstone Way Nine Mile Falls WA 99026 Ph: (509) 464-3627 |
NPI Number | 1831214329 |
---|---|
Provider Enumeration Date | 03/21/2007 |
Last Update Date | 07/18/2023 |
Medicare PECOS PAC ID | 1951202373 |
---|---|
Medicare Enrollment ID | O20080814000240 |
Identifier | Type | State | Issuer |
---|---|---|---|
1831214329 | NPI | - | NPPES |
Taxonomy | Type | License (State) | Status |
---|---|---|---|
261QF0400X | Clinic/center - Federally Qualified Health Center (fqhc) | J600317870 (Washington) | Primary |